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When measles presents with coldness in the lower body, it differs from epidemic pestilence (severe infectious diseases). The condition of a warm head and cold feet is viewed as a *ni zheng* (reverse syndrome, indicating deterioration and poor prognosis). Since the rash emerges from the upper part, heat accumulates above while coldness remains below. If upper heat and lower cold occur at the initial stage, it is acceptable; however, if the lower body remains cold after the rash has fully erupted, it constitutes a reverse syndrome requiring careful examination and treatment. In cases where the body and limbs are cold as ice, since measles inherently belongs to Fire, the whole body should naturally be warm. Coldness indicates a reverse syndrome. If there is no fever during the active eruption phase, the pathogenic toxin cannot be fully expelled and may gradually recede. If such symptoms appear after the rash has just subsided, it implies severe damage to the Spleen and Stomach, extreme deficiency of Qi and Blood, and incomplete expulsion of toxins, leading to infinite complications. This is deemed incurable, hence no specific formula is provided.

Mouth ulcers are caused by Fire of the Heart and Spleen, commonly appearing when the rash is about to subside. This results from residual toxins lingering in the Upper Jiao. Symptoms typically include constipation and dark red urine. Treatment should focus on clearing and draining Spleen Fire and lubricating the Large Intestine. For nursing mothers, medication should also be administered to cool the breast milk.

Abdominal pain associated with measles occurs because toxic vapors act internally and fail to penetrate the exterior. It is most common during the initial or active eruption phases. Treatment should employ methods to disperse and support the expulsion of toxins; pain ceases once the rash erupts. If pain occurs when the rash is beginning to subside but not yet complete, it is due to residual external pathogens returning inward. Treatment similarly requires dispersing and supporting, assisted by cooling agents. Subtle adjustments must be made based on clinical judgment and external symptoms.

Vomiting of phlegm manifests in two forms: stringy or clumped. Both result from long-standing accumulation of Fire in the Lung and Stomach. Treatment should prioritize clearing the Lung, resolving phlegm, and descending Fire. Medicinals such as *Arisaema Cum Bile* (*Nan Xing*) and Pinellia Rhizome (*Ban Xia*), which are aromatic, dry, and warming to the Spleen, must be avoided.

Dry tongue coating generally relates to the Spleen. Spleen Heat presents in two degrees: mild heat manifests as white lips with dryness; severe heat manifests as red lips with dryness. Even more severe is purple-black dryness. Treatment involves clearing heat and promoting diuresis/diffusion. Why? The tongue is the sprout of the Heart. Measles belongs to Fire, corresponding to the Heart. Thus, tongue coating appears in three colors: yellow, white, and black. White indicates mild heat; yellow, though severe, is treatable; black is difficult to treat. Regardless of the disease stage, the approach remains clearing heat and promoting diffusion. Cracked tongue and fissured lips result from excessive Fire in the Heart and Spleen rushing upward, presenting with deep red or purple-black coloration. Severe redness without purple hues also indicates intense Fire. Treatment depends on the disease stage. Initial fever with red color suggests unresolved Fire and unexpelled toxins. If the color retains vitality, it is treatable using cooling herbs combined with dispersing and supporting methods. Purple-black, scorched, and lifeless coloration is incurable. Appearance of these signs after eruption is difficult to treat, as it indicates damage to both the Heart and Spleen meridians. Appearance before resolution is also a critical sign requiring cautious observation.